Provider Demographics
NPI:1396866638
Name:BRUCE, JESSICA ANN (OT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:286 DEYO HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-798-1002
Mailing Address - Fax:607-687-1042
Practice Address - Street 1:286 DEYO HILL ROAD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-798-1002
Practice Address - Fax:607-687-1042
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1316225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist